Provider Demographics
NPI:1538203971
Name:PACIFIC WOMEN'S MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:PACIFIC WOMEN'S MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-562-1100
Mailing Address - Street 1:PO BOX 1567
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-1567
Mailing Address - Country:US
Mailing Address - Phone:323-562-1100
Mailing Address - Fax:323-562-1101
Practice Address - Street 1:4750 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1351
Practice Address - Country:US
Practice Address - Phone:323-562-1100
Practice Address - Fax:323-562-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51569207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A515690Medicare ID - Type UnspecifiedMEDICAL
CAG15780Medicare UPIN
CA00A515693Medicare ID - Type UnspecifiedMEDICAL